CDC COMMUNITY GUIDE: Cancer Prevention & Control, Client-Oriented Screening Interventions: Client Reminders

Client reminders are written (letter, postcard, email) or telephone messages (including automated messages) advising people that they are due for screening. Client reminders may be enhanced by one or more of the following:
• Follow-up printed or telephone reminders
• Additional text or discussion with information about indications for, benefits of, and ways to overcome barriers to screening
• Assistance in scheduling appointments

These interventions can be untailored to address the overall target population or tailored with the intent to reach one specific person, based on characteristics unique to that person, related to the outcome of interest, and derived from an individual assessment.

The Community Preventive Services Task Force recommends the use of client reminders to increase screening for breast and cervical cancers on the basis of strong evidence of effectiveness. The Task Force also recommends the use of client reminders to increase colorectal cancer screening with fecal occult blood testing based on strong evidence of effectiveness.

The goal of the Client Reminders is to increase screening for breast cancers.

The Community Preventive Services Task Force (CPSTF) recommends the use of client reminders to increase screening for breast cancers on the basis of strong evidence of effectiveness.

Results From The Systematic Reviews:

Breast Cancer:
The original review included 22 studies and 38 study arms. The update included an additional 6 studies. Combined evidence from both the original and the updated review showed the following:
• Mammography screening: median increase of 14.0 percentage points (interquartile interval [IQI]: 2.0 to 24.0 percentage points; 19 study arms).
Recent mammography screening: median increase of 12.3 percentage points (IQI: 3.0 to 18.9 percentage points; 30 study arms).
• Repeat mammography screening: median increase of 6.0 percentage points (IQI 3.0 to 19.1 percentage points; 8 study arms).
• Enhanced and telephone reminders showed a greater increase (15.5 percentage points [IQI 7.0 to 29.0 percentage points]; 20 study arms) than written reminders alone (4.5 percentage points [IQI: 1.9 to 14.0 percentage points]; 14 study arms).
• When added to other types of interventions, the median incremental effect for client reminders was an increase of 5.0 percentage points (IQI 1.6 to 6.7 percentage points; 12 study arms).
• Client reminder interventions to increase breast cancer screening should be applicable across a range of settings and populations, provided they are adapted to the target population and delivery context.

Cervical Cancer:
The original cervical cancer screening review included 11 studies with 15 study arms:
• Pap test: median increase of 10.2 percentage points (IQI 6.3 to 17.9 percentage points; 14 study arms).
• Enhanced and telephone reminders showed greater increase (15.5 percentage points; 6 study arms) than written reminders alone (9.8 percentage points; 9 study arms).

The updated review included 6 additional studies:
• Pap test: median increase in use was 2.8 percentage points (range 1.6 to 31.4; 4 studies).
• Enhanced and telephone reminders showed an increase of 1.6 to 31.4 percentage points (3 studies; 4 study arms).
• The incremental effect client reminders added to provider-directed interventions was a median increase of 3.7 percentage points (range -3.5 to 25.2; 5 study arms).
• Client reminder interventions to increase cervical cancer screening should be applicable across a range of settings and populations, provided they are adapted to the target population and delivery context.

Colorectal Cancer:
The original colorectal cancer review included 4 studies with 8 study arms.
• Screening by FOBT: median increase of 11.5 percentage points (interquartile interval [IQI] 8.9 to 20.3 percentage points).

The updated review included 3 additional studies. Combined evidence from both the original and the updated review showed the following:
• When added to other types of interventions, the median incremental effect for FOBT use was an increase of 10.9 percentage points (IQI 6.0 to 13.5 percentage points; 5 studies, 9 intervention arms).
• The estimated effect for other types of colorectal screening was low.
• Client reminder interventions to increase colorectal cancer screening by FOBT should be applicable across a range of settings and populations, provided they are adapted to the target population and delivery context.